Trevicta is an extended-release, three-month injectable antipsychotic medication used for the maintenance treatment of schizophrenia in adults. Its active ingredient, paliperidone palmitate, is a long-acting form of paliperidone, an atypical antipsychotic. Unlike daily oral medications, Trevicta requires administration only once every three months, which can significantly improve medication adherence and reduce the risk of relapse for patients who are already stable on a monthly injection of paliperidone.
How Trevicta Works in the Body
The therapeutic effects of Trevicta come from its active ingredient, paliperidone, which is the primary active metabolite of the older antipsychotic, risperidone. Paliperidone's mechanism of action involves interacting with neurotransmitters in the brain, primarily by blocking receptors for dopamine ($D2$) and serotonin ($5-HT{2A}$). By blocking these receptors, it helps to rebalance brain chemistry and reduce the intense, disorganized thoughts and behaviors associated with schizophrenia.
The long-acting nature of Trevicta is due to its formulation. The paliperidone is attached to a fatty acid to create paliperidone palmitate, a molecule with very low water solubility. After a healthcare professional injects the suspension into a muscle, it forms a depot. The paliperidone palmitate slowly dissolves over several months before being converted to active paliperidone and absorbed into the bloodstream. This process ensures a consistent therapeutic level of medication is maintained in the body, preventing the peaks and troughs seen with daily oral dosing.
Benefits of a Long-Acting Injectable Antipsychotic
For many patients with schizophrenia, adhering to a daily oral medication regimen can be challenging, often due to the symptoms of the illness itself. The use of a long-acting injectable like Trevicta offers several important benefits:
- Improved Adherence: The infrequency of dosing (once every three months) eliminates the need for daily pill-taking, reducing the chance of missed doses that can lead to symptom relapse.
- Relapse Prevention: Clinical studies have shown that Trevicta is effective at preventing relapse, a critical outcome for individuals with schizophrenia.
- Stable Medication Levels: The slow-release formulation leads to more stable plasma drug concentrations compared to oral medications, which can lead to a more consistent therapeutic effect and potentially fewer side effects.
- Increased Insight: The predictable administration schedule provides a clear indicator of medication adherence, enabling healthcare teams to intervene proactively if a dose is missed.
- Patient Preference: Some patients simply prefer the convenience of fewer, less frequent injections over the daily task of taking pills.
Transitioning to Trevicta
Patients cannot be started on Trevicta directly from other antipsychotics. A careful transition process is required to ensure stability and tolerability. The process typically follows these steps:
- Oral Tolerance: The patient is first stabilized on an oral formulation of paliperidone or risperidone to assess for any adverse reactions.
- Transition to Monthly Injection: The patient must then be transitioned to the once-monthly paliperidone palmitate injectable (e.g., Invega Sustenna or Xeplion) for a minimum of four months to ensure clinical stability.
- Switch to Trevicta: Once stable on the monthly injection, the patient can be switched to Trevicta. The first Trevicta dose is given at the time the next monthly injection would be due. The Trevicta dose is approximately 3.5 times the monthly dose.
Trevicta vs. Invega Sustenna
| Feature | Trevicta (US: Invega Trinza) | Invega Sustenna (EU: Xeplion) |
|---|---|---|
| Dosing Interval | Once every 3 months | Once every month |
| Indication | Maintenance treatment for stable patients | Acute and maintenance treatment |
| Active Ingredient | Paliperidone palmitate | Paliperidone palmitate |
| Mechanism | Blocks dopamine and serotonin receptors | Blocks dopamine and serotonin receptors |
| Prerequisites | Must be stable on monthly injection for at least 4 months | None (can be initiated directly) |
| Administration Site | Deltoid or gluteal muscle | Deltoid or gluteal muscle |
| Key Advantage | Greater convenience and adherence due to less frequent dosing | Used for stabilization before switching to Trevicta |
Important Considerations and Contraindications
- Monitoring: Healthcare professionals must monitor for side effects, as the long-acting nature means they can persist for an extended period.
- Kidney Impairment: Trevicta is not recommended for patients with moderate or severe kidney problems.
- Allergy: It is contraindicated in patients with a known hypersensitivity to paliperidone, risperidone, or any of its ingredients.
- Not for Agitated Patients: Trevicta should not be used to treat acutely agitated or severely psychotic patients.
- Diabetes: Atypical antipsychotics like paliperidone may cause hyperglycemia, so monitoring is required for diabetic patients.
Conclusion
Trevicta Injection serves as a crucial maintenance treatment for adult patients with schizophrenia who have achieved stability on a monthly paliperidone regimen. By providing a three-month dosing interval, it offers significant advantages in convenience, adherence, and relapse prevention. The extended-release formulation ensures consistent symptom control by steadily releasing the active ingredient, paliperidone, into the bloodstream. While it requires a careful transition period and patient monitoring, Trevicta represents a major advancement in the management of schizophrenia, allowing many patients to focus less on daily medication and more on their overall well-being. For more information, please consult the product information available through the European Medicines Agency (EMA).
